Low-dose cyclosporin A in palmoplantar psoriasis: evaluation of efficacy and safety

Background The immunosuppressant cyclosporin A has been used with success in the treatment of chronic plaque-type psoriasis; little is known about its effect on palmoplantar psoriasis. Subjects and methods Thirty-three patients (12 women, 21 men; mean age = 44.2 years, range 22-68 years) with palmoplantar psoriasis were treated with oral cyclosporin A, (CyA), 2.5 mg/kg/day, which could be increased to 5 mg/kg/day, for 12 weeks. Patients were followed up for a further 4 weeks without CyA treatment. A total of 26 patients completed the 12-week treatment course, an additional six patients were followed up during 4 weeks after premature withdrawal. Efficacy was assessed by calculating the Psoriasis Area and Severity Index (PASl). a Local Psoriasis Severity Index (LPS1), and estimation of the area involved. Results Clinical response, being defined as at least 50% reduction of these parameters at the end of the therapeutic phase compared to baseline before treatment, was reached in 84% of the patients; 61% of the patients showed clinical response after only 6 weeks of treatment. No signs of severe hepatic or renal toxicity were noted during the study period; mild hypertension, which developed in one case, resolved after termination of the treatment. Relapses after treatment never reached the pretreatment baseline levels. Conclusions It is concluded that palmoplantar psoriasis can be treated effectively and safely with oral CyA at the low-dose range of 2.5-5 mg/kg/day. The results demonstrate the necessity for evaluation of a maintenance treatment in this special form of psoriasis, the doses and safety of which remain to be determined in future controlled clinical trials.